WHEN BYRON MacLEAN was forced to retire from his police job in Nova Scotia for medical reasons last year, he saw a psychotherapist to deal with post-traumatic stress disorder from military duty in Afghanistan and time on the force. But after a while, talk therapy stopped working. His depression, anxiety, and night terrors returned, straining his marriage. “I felt really stuck,” says MacLean, 43. Then a military buddy told him about ketamine—the psychedelic drug that doctors have used for decades as an anesthetic and pain reliever and that has gained new popularity as a possible wonder drug for mood disorders.
MacLean was initially scared it would send him on a bad hallucinogenic trip. Or worse, that it wouldn’t work and he would be out of options. MacLean isn’t alone in weighing the pros and cons of ketamine. In 2019, the U. S.Food and Drug Administration approved a nasal-spray version used in conjunction with an oral antidepressant for people for whom other depression treatments had failed. But psychiatrists had already been prescribing the psychedelic, a short-acting anesthetic that induces a trancelike state, as a treatment for lingering depression.
Now there’s intense interest in the idea that ketamine might be the next best thing to alleviate the country’s mental-health crisis—at a time when it’s never been harder to find counseling. And ketamine isn’t difficult to get. Clinics like Field Trip, a Toronto-based company, have numerous locations in the United States. Telemedicine companies like Mindbloom, TripSitter.Clinic, and My Ketamine Home will ship you ketamine lozenges that you can take at home. All this said, some experts are calling for tighter regulation. While they generally agree that the drug itself is pretty safe, advertising and marketing may be overpromising what ketamine can actually deliver. Here’s what to know now:
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The Effect Tends to Fade
Ketamine clinics are apt to promise speedy relief. And for the most part that’s true: One recent Columbia University study found that suicidal patients were significantly less depressed and were less likely to hurt themselves within 24 hours of taking a single dose of ketamine. Except experts agree that the benefits can be fleeting. (People taking ketamine for depression often relapsed within three weeks, according to a small 2013 study.) That’s a major downside for anyone paying several thousand dollars for a series of treatments. “The vast majority of ketamine clinics are opening up with the business model of dosing people and sending them on their way. It’s limited in its effectiveness,” says Alan K. Davis, Ph.D., director of the Center for Psychedelic Drug Research and Education at Ohio State University in Columbus. For changes to stick, research shows it’s best to pair ketamine with psychotherapy. “Often people have a meaningful experience, but that doesn’t solve the underlying problem,” Davis says. “Where the rubber meets the road is what happens outside the session and how you change your life.”
You Need the Right Dose and the Right Reasons
At many clinics, patients often don’t receive a high enough dose for the treatment to be effective, says Steven P. Cohen, M.D., a ketamine researcher and a professor at Johns Hopkins School of Medicine. Other concerns have emerged about clinics making dubious claims, failing to adequately screen patients, or administering inconsistent dosages.“I know of places where you don’t have to have a diagnosis for depression or anxiety,” says Austin-based psychiatrist and MH advisor Gregory Scott Brown, M.D., who’s among a chorus of experts calling for more regulation of the ketamine industry. Even the most promising of drugs won’t work if they’re not given for a condition they can actually help treat.
It’ll Cost You
A treatment package from Field Trip consisting of a screening, a prep session, four ketamine sessions, and three integration sessions with a therapist runs about $3,500. Clinic treatments like this are rarely covered by insurance, and if they are, there are usually hoops. For insurance to pay for the FDA-approved treatment sold under the brand name Spravato, you typically must show proof you’ve taken two other antidepressants for at least six weeks and failed to derive any benefit.
So people may be tempted to get it on the street. Never a good idea, says Jedidiah Ballard, D.O., an emergency room physician and MH advisor in Augusta, Georgia. He’s concerned about the purity of the ketamine you could wind up with this way and what can happen if you don’t have a mental-health pro there to guide you through.
Having a bad trip is another risk, says psychologist Keith Trujillo, Ph.D., who studies ketamine at California State University San Marcos. “K-land can be a positive, blissful experience. Colors look more vivid. People see or hear things differently,” he says. “They also report the ‘K-hole.’ People feel separated from themselves or think they’ve died. That can be anxiety provoking.”
Last fall, MacLean, the former police officer, decided to undergo ketamine treatment. In a New Brunswick treatment-center room decorated with potted plants and thick floor cushions, he sat beside a counselor for the next hour and a half. The counselor placed a ketamine lozenge under MacLean’s tongue (the drug is administered as an injection in the U. S.) and MacLean closed his eyes. At first, he says, the experience was comforting; he sensed he was floating in the sky and told himself, as an eight-year-old boy, “Everything is going to be okay.” Then he saw a shoe he’d found belonging to an 18-year-old woman who had been choked to death by her boyfriend in the woods in 2013. MacLean had long questioned whether he could have changed the outcome—if only he’d intervened earlier when he suspected her abusive boyfriend was in town. Yet the ketamine helped him let go of his guilt. “I realized I couldn’t be responsible for someone else’s decisions,” he says. “Ketamine gives you distance to process traumas differently and then just leave them there.”
After additional treatments and therapy sessions, MacLean says, his home life is now more harmonious. He can let things go more easily, has started working out again, and is able to live more in the moment. “I just wish I’d done this sooner,” he says. Ketamine may help mental health care in a broader way, too: by opening minds to psychedelic drugs as legitimate therapies. Several biotech companies are patenting other psychedelic treatments, and Davis is studying the potential of psilocybin to treat depression with longer-term success. “Our society tends to focus on the harms of drugs,” he says. “Ketamine is starting to change the narrative about the positive effects.” Yet with ketamine, as with all things concerning your health, it’s on you to plan your trip the smart way.
Make Sure A Ketamine Provider Offers These Things
Whether you get it from a clinic or from an individual doctor, make sure you check all of these boxes first, says psychiatrist and MH advisor Gregory Scott Brown, M.D.
Monitoring before and after treatment
If you’re receiving your ketamine through the mail, you should be regularly monitored by a health-care professional who is trained to address your expectations for the therapy, spot signs of psychosis and addiction, help you make sense of the sessions, and know the nuances of depression.
Proper screening
Check with a psychiatrist before trying this if you have a history of schizophrenia or bipolar disorder; there have been reports of mania and worsening psychosis. Also check in if you have a heart issue or uncontrolled high blood pressure.
Treatment for a valid reason
If someone is willing to prescribe ketamine for “an existential crisis” or to “help you relax,” go elsewhere.
This story originally appeared in the July/August 2022 issue of Men’s Health.
Sarah Elizabeth Richards is a San Diego-based health and science journalist who has written for The Washington Post, Smithsonian and The Atlantic.
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